Others at risk

In addition to baby boomers, other people are also at increased risk for hepatitis C. They include:

•Anyone who received a blood transfusion or organ transplant before 1992.

•Anyone who used intravenous drugs, even once.

•Anyone who received a piercing or tattoo using unsterile equipment.

•Anyone who has HIV.

•Anyone who works in health care and has been exposed to infected blood.

•Anyone who was born to a woman with a hepatitis C infection.

•Anyone who has had unprotected sex with multiple partners.

Protect yourself from hepatitis C infection by taking the following precautions:

•Avoid using intravenous drugs or sharing needles.

•If you get tattoos or body piercings, ensure the environment and tools are clean and sterile.

•Avoid unprotected sex with multiple partners or with any partner whose health status is uncertain.

— J.B.

Know your ABCs

Hepatitis A, B and C are all contagious viruses that can cause liver disease. Here’s how they differ:

Hepatitis A

How is it spread? By either direct contact with an infected person’s feces or by indirect fecal contamination of food or water.

How long does it last? Infection can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months.

Is it curable? Yes. Patients usually improve without treatment and the virus is not chronic.

Is a vaccine available? Yes.

Hepatitis B

How is it spread? By contact with an infected person’s blood or body fluids. It may also be passed from mother to child during birth.

How long does it last? Infection can range in severity from a short, mild illness to a serious, lifelong illness.

Is it curable? No, the virus remains in your body.

Is a vaccine available? Yes.

Hepatitis C

How is it spread? By contact with an infected person’s blood. It may also be passed from mother to child during birth.

How long does it last? Without treatment, it can progress in severity over decades and cause severe liver damage, liver failure or liver cancer.

Is it curable? Yes, in some cases.

Is a vaccine available? No. — J.B.

5 million

Approximate number of Americans who have hepatitis C.

15,000

Number of U.S. deaths per year at least partly caused by hepatitis C.

80%

of American boomers who do not consider themselves at risk for the disease.

The baby boomer generation is associated with a number of notable events, including the advent of the Beatles, the civil rights movement and the first moon landing. Now, medical experts are adding hepatitis C infections to that list.

Recently, the Centers for Disease Control (CDC) recommended that everyone born from 1945 through 1965 have a one-time screening for hepatitis C virus, a serious liver disease that is spread through direct contact with infected blood. Chronic hepatitis C can lead to serious and life-threatening liver problems and is the leading cause of liver damage, cirrhosis or scarring of the liver tissue, liver failure or liver cancer. It is the most common reason for liver transplants, and responsible for about 15,000 deaths annually in the U.S.

According to the American Gastroenterological Association (AGA), 82 percent of the nearly 5 million Americans with hepatitis C are baby boomers. Moreover, 75 percent of those infected are unaware that they have the virus.

Why is the prevalence so high among baby boomers?

“The epidemic really took place in the United States during the 1960s and ’70s. The population born between 1945 and 1965 was receiving untested blood transfusions, going to Vietnam, using IV drugs, having multiple sex partners and they were inadvertently infected with hepatitis C,” explained Dr. Paul Pockros, head of gastroenterology/hematology at Scripps Clinic. “The number of new infections started to decline in the 1990s, when blood began to be tested.”

Though medical experts have long known that baby boomers are more likely to have hepatitis C, the conventional screening tactics have not been effective.

“The current screening method of asking patients if they’ve ever used IV drugs or had a blood transfusion wasn’t working,” said Pockros, noting that many primary care physicians weren’t asking the questions or testing those patients who should have been tested. ”So we knew roughly 75 to 80 percent of the infected population was not being screened.”

The new blanket screening guidelines resulted from several factors. It is much more cost-effective to proactively screen all patients and treat those who are infected than to treat them for serious liver disease later; treatment for liver disease patients can cost between $60,000 to $100,000 per year. Additionally, researchers previously believed that only 20 percent of infected baby boomers would develop cirrhosis of the liver. However, because many boomers have been infected for decades and liver damage from hepatitis C worsens over time, that number is now proving to be much higher.

Compared with the current method of screening, age-based screening could identify more than 800,000 additional cases of chronic hepatitis C and, when followed by treatment, could reduce total deaths by 121,000.

Hepatitis C is often referred to as a “silent killer” because it frequently goes undetected, progressing without symptoms for decades until the liver is severely damaged. Up to 70 percent of newly infected patients have no symptoms; others may have very mild, general symptoms such as fever, fatigue, abdominal pain, nausea, vomiting, poor appetite, dark urine or jaundice. Because many patients with these vague symptoms are unlikely to seek medical care, they don’t know they are at risk for chronic liver disease. Moreover, they may spread the virus to others for decades after contracting it.

That’s why screening is so important, especially for baby boomers and others at increased risk. Through a simple blood test, your doctor can determine whether you have the hepatitis C virus, measure the amount of virus in your blood, and establish treatment options. If you test positive, your doctor also may recommend a liver biopsy to evaluate the extent of any liver damage and make further treatment decisions.

While biopsy is still the standard to determine the extent of damage and make treatment decisions, it may not be necessary in the future.

“We’re doing liver biopsy because therapy is less than ideal right now and we’re deciding who needs to be treated and who doesn’t,” Pockros said. “As therapy improves we’ll stop doing biopsies altogether and just treat everybody.”

Approximately 15 percent to 25 percent of persons diagnosed with hepatitis C clear the virus from their bodies without treatment.

“These are the people who actually self-cure because they have a genetic predisposition to clear the virus with their robust immune response,” said Dr. Robert Gish, chief of hematology at UC San Diego Health System. “This is the main factor in whether it becomes chronic. If you have HIV, or have had an organ transplant, or are immune-suppressed, the risk for chronicity is much higher.”

The majority of hepatitis C patients who need treatment are treated with antiviral medications that work to clear the virus from the body. Often, patients take a combination of medications for up to 48 weeks. However, some of these medications, such as interferon injections, can cause depression and flu-like symptoms such as fatigue, fever and headache. Should these side effects become intolerable, treatment may be stopped. Patients who can’t tolerate treatment must make very healthy lifestyle decisions, such as avoiding alcohol, marijuana and drugs that can harm the liver, Gish said.

Moreover, even after a person is treated for hepatitis C, they can become reinfected. There are at least six different genotypes or genetic forms of the virus, and more than 50 subtypes. The virus can mutate and replicate very quickly, which may explain how it becomes chronic. This makes both treatment and the development of a vaccine very challenging.

“Hepatitis C is curable in the sense that the virus can be eliminated from the body completely in some patients with the right treatment. Not everybody right now is getting cured,” Gish said. “The good news is, with the new drugs coming out, therapy will be changed from injectable therapy with a lot of pills to pills only, and instead of 48 weeks of treatment for most patients, the duration might drop as low as 12 weeks quite soon. The cure rate will go much, much higher in the next five years.”

Gish expects the next phase of new drug treatment to reach the market in late 2014 or early 2015.

“There are currently 40 to 50 drugs in development, and as therapies improve we are going to be able to cure the majority of patients without interferon-based therapy,” Pockros said. “We’ll likely treat everybody, because you’d rather not be infected than be infected. So it will become much more compelling to identify this population now than in prior years.”

Mary S., who asked that her last name not be published for privacy reasons, is currently undergoing hepatitis C treatment. Diagnosed by her primary care doctor after routine blood tests indicated that her liver enzymes were elevated, Mary believes she contracted the virus from a past roommate who worked in health care and was exposed to a great deal of blood.

Mary is now completing a 12-month treatment regimen of oral antivirals and interferon injections. Though she has experienced a number of side effects including flu symptoms, rash, fatigue, thinning hair and anemia, she says they’re “not that bad.” The 56-year-old has continued to work throughout her treatment and recently ran a 5K.

Mary stresses the importance of testing, and wants to eliminate the stigma associated with the virus. “Anyone can have hepatitis C. You can get it from helping a kid with a scraped knee,” she says. “Absolutely get tested. I lost somebody very close who did not know they had it and didn’t have treatment. It was horrible, and it doesn’t have to end that way.”